Capalbo Alessandro1, Gagliostro Nazareno1, Balampanos Charalampos Georgios1, Bushati Vilma2, Persechino Flavia3, Giordano Domenico4, Persechino Severino4*
1Sapienza University of Rome, Sapienza University of Rome, NESMOS Department, Dermatology Unit, Sant Andrea Hospital Faculty of Medicine and Psychology Roma, Lazio, Italy
2University Cattolica Nostra Signora Del Buon Consiglio, Medicine Tirana, Albania
3Sapienza University of Rome, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy Roma, Lazio, Italy
4Sant Andrea Hospital, NESMOS, Dermatology Unit, Italy
*Corresponding Author: Prof. Persechino Severino MD, PhD, Head of Dermatology Unit, Sant Andrea Hospital Rome, Italy; Email: [email protected]
Published Date: 18-03-2021
Copyright© 2021 by Severino P, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Since the COVID-19 pandemic raised all over the world a year ago, many dermatological manifestations have been reported in COVID-19 patients including alopecia areata, erythematous rash, widespread urticaria and chickenpox-like vesicles and Chilblain-Like Acral Skin Lesions. This is the first case reported of morphea in a 62 years old Caucasian woman diagnosed during recovery from Sars-Cov-2 pneumonia in January 2021. She presented to our clinic in Saint’ Andrea hospital in Rome with multiple white sclerotic skin lesions with erythematous halo (lilac ring) all over the trunk. After blood tests, HRCT, serological tests and skin biopsy the only clinical reference was COVID-19 infection. Therefore, knowing that COVID-19 is related to immunological mechanisms we assume that both conditions are related. The pathways of connection between morphea and COVID-19 are still unknown that’s why further studies are needed.
Keywords
Skin Lesions; COVID-19; Morphea; Autoimmune Diseases
Introduction
Localized scleroderma or also known as morphea, is a disease that involves the skin causing it to harden with loss of elasticity (scleroderma literally means “hard skin”). It can be subdivided into plaque morphea and its subtypes, as well as generalized morphea, linear scleroderma and deep morphea. Plaque morphea is the most common form of LSc. It is characterized by the onset of one or more circumscribed plaques of skin hardening with variable dyschromia [1-3]. The plaques are initially erythematous and edematous, then become indurated, but not bound to underlying structures. These plaques are more common on the trunk than the extremities. The annual incidence of a localized scleroderma is estimated at 20 per million [4]. The ratio of females to males was 2.6:1, almost three times more it affects women than men [3]. The onset is usually in the third or fourth decade. Although morphea is usually a localized disease, it may be associated with serological abnormalities and other systemic immune diseases, including systemic scleroderma, lupus erythematosus, biliary cirrhosis, eosinophilia myalgia, and myositis [5,6]. Since the COVID-19 pandemic arised all over the world a year ago, many dermatological manifestations have been reported in COVID-19 patients including alopecia areata, erythematous rash, widespread urticaria and chickenpox-like vesicles and Chilblain-Like Acral Skin Lesions [5,7]. This is the first case reported of morphea in a post COVID-19 patient.
Case Report
In this case report we present a 62 years old Caucasian woman diagnosed with morphea during recovery from Sars-Cov-2 pneumonia in January 2021. She presented to our clinic in Saint’ Andrea hospital in Rome with multiple white sclerotic skin lesions with erythematous halo (lilac ring) all over the trunk. HRCT scan showed some hyperdensity areas in the right lung compatible with COVID-19 interstitial pneumonia. Blood tests were normal. Serologic tests for Anti-Ro52, AntiRo60, Anti La, Anti Sm, Anti Jo1, AntiScl70, Anti RNP ANA antibodies were negative. Complement component C3 and C4 were within normal limits. Skin biopsy of the lesions found sclerosis associated with lymphoplasmacytic infiltrate associated to atrophic eccrine glands and replacement of the adipocyte cells with collagen confirming the diagnosis of Localized Scleroderma or Morphea. There were no signs of melanocyte lack on the biopsy. Earlier studies related morphea to other concomitant autoimmune diseases like lupus erythematosus, vitiligo, alopecia areata, rheumatoid arthritis and autoimmune thyroiditis [5,1]. Ten years ago our patient had manifestations of vitiligo without new manifestations over the years [8].
The scleroderma lesions were treated with topical corticosteroids, respectively Clobezol for three weeks and there has been a major improvement of the lesions, noted as reduced erythema (Fig. 1 and 2) and reduced induration on palpation.
Figure 1: White sclerotic lesions with erythematous halo (lilac ring) before Clobezol treatment.
Figure 2: After three weeks of Clobezol treatment.
Discussion
Earlier studies describe viral infections as a risk factors for Morphea, respectively CMV, Borrelia [9]. Although the origin of LSc is unknown, it is postulated that the disease process is related to immune activation and vascular damage that leads to connective tissue dysregulation [4]. In the early stages of the disease because of the vascular damage there is a high release of cytokines, adhesion molecules and T-cell infiltration and activation [2]. SARS‐CoV‐2 could act as a trigger by creating an inflammatory environment which allows the nonspecific activation of the immune system or by a cross‐reaction between its antigens and host antigens [5].
Conclusion
We’re reporting the first case of morphea in a COVID-19 patient in recovery and we’re a step ahead on having a clear idea on COVID-19 virus immunological mechanisms but further studies are needed to confirm the relation between autoimmune diseases in general and in specific morphea and COVID‐19.
References
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Article Type
Case Report
Publication History
Received Date: 09-02-2021
Accepted Date: 10-03-2021
Published Date: 18-03-2021
Copyright© 2021 by Severino P, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Severino P, et al. Morphea (Localized Scleroderma) in a COVID-19 patient: A Case Report. J Clin Immunol Microbiol. 2021;2(1):1-4.
Figure 1: White sclerotic lesions with erythematous halo (lilac ring) before Clobezol treatment.
Figure 2: After three weeks of Clobezol treatment.
